HAPPY VALLEY SKATE PARK
FUNDRAISING BRICK ORDER FORM
Name:
Address:
Email:
Phone #:
State:
Zip Code:
8" x 8" Brick $200.00
4" x 8" Brick $100.00
Date:
Signature:
Help us raise money to build a new brick walkway leading to
the skate park. Your brick purchase can be:
*a lasting memorial for a family member or friend
*used to advertise your business name
*used to list your family's name as a donor
Please print clearly and use all
CAPITAL letters.
14 characters per line, 3 lines
maximum for the 4" x 8" brick. 14
characters per line, 5 lines maximum
for the 8" x 8" brick.
Spaces and hyphens are considered
characters. There is no need to
center your own lettering. This will
automatically be done when bricks are
engraved.
The City of Happy Valley reserves the
right to refuse any inscription that is
determined to be inappropriate for
this project.
All bricks will be placed randomly
throughout the project. We cannot
guarantee positioning due to the
nature of the project.
The City of Happy Valley is not
responsible for errors due to
incorrectly submitted forms.
For Office Use
Rec'd By:
Amount Paid:
“The City of Happy Valley is a tax exempt organization. Charitable
contributions are tax deductible and receipts will be provided upon
donation.”
Tax ID 93-0585196
Paid By:
Check
#_____
Credit
Card
Cash
Print Form
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